Healthcare Provider Details

I. General information

NPI: 1982456448
Provider Name (Legal Business Name): NEDRA ELEANA BRIDGEWATERS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2024
Last Update Date: 04/05/2024
Certification Date: 04/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8530 TOWNSHIP LINE RD
INDIANAPOLIS IN
46260-1927
US

IV. Provider business mailing address

8639 N COUNTY ROAD 235 W
BRAZIL IN
47834-7225
US

V. Phone/Fax

Practice location:
  • Phone: 463-999-9045
  • Fax:
Mailing address:
  • Phone: 812-531-3033
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number28194806A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: